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Massachusetts rates for HCPCS 15221

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $2,691.53 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $112.20 / $323.59
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $1,995.26 / $28,840.32
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $144.54 / $380.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $79.43 / $181.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $147.91 / $316.23
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.18 / $501.19 / $7,079.46
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $181.97 / $263.03
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $2,041.74 / $3,467.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $151.36 / $338.84
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $1,995.26 / $28,840.32
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $147.91 / $389.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $1,862.09 / $2,818.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $147.91 / $295.12